A 2022 article by Robert J. Cramer, Andréa R. Kaniuka, and Lewis J. Peiper—published in Psychological Services—provides a self-injury and suicide prevention model for corrections, with the goal of providing evidence-based training and and practical guidance for correctional mental health providers. Here, we summarize the article, highlighting key elements useful for practitioners in the field.
Self-Directed Violence in Corrections
Self-directed violence (SDV) includes both self-injury and suicide and "is a pressing health matter in correctional settings." While suicide always carries with it the intent to terminate one's life, self-injury is intentional but nonsuicidal and can be directed toward multiple purposes, such as self regulation, attention seeking, or a cry for help).
"SDV comprises a pressing public health dilemma for correctional institutions in the U.S."
Within the U.S., approximately 2% of incarcerated individuals engage in self-injury and report, with 85% of prison systems in the country reporting daily occurrences. In U.S. jails, suicide is the leading cause of death for incarcerated individuals "and the third leading cause of death among persons incarcerated in state prisons."
"While national-level data on suicidal ideation is limited, facility-level prison and jail data indicate a suicidal ideation prevalence while incarcerated of approximately 15%–16%," five times higher than the general (nonincarcerated) population.
The prevalence of SDV in corrections has been attributed to the presence of multiple risk factors for incarcerated individuals, including:
- Depression, anxiety, and feelings of hopelessness;
- Substance use disorder;
- Solitary confinement;
- Punitive disciplinary actions; and
- Experiencing victimization.
Steps for preventing SDV in any setting fall into four areas:
- Maintaining written policies approved by experts in suicide prevention;
- Holding staff training annually;
- Using evidence-based clinical practices for screening, assessment, terminology, staff communications, and risk management; and
- Utilizing best practices post-intervention.
"Despite existing best practice prevention strategies, the need for enhanced SDV prevention practices in correctional settings exist for several reasons." The regularity of self-injury by incarcerated individuals not only indicates a greater need for treatment; however, "self-injury is often ignored in corrections prevention and risk management research and practice." There is both a legal and ethical risk posed by not establishing and maintaining SDV prevention best practices within correctional settings. Yet, implementation of SDV prevention often varies significantly when comparing institutional practices among correctional facilities.
Core Competency Model for Corrections
The authors' goal in this article was "to outline the curriculum and evaluation considerations" for an educational program that follows best practices that can be used specifically for corrections. The Core Competency Model (CCM) is an "an established suicide prevention educational train- ing approach that has been applied to a variety of settings."
To create the CCM for Corrections, the authors tailored the existing public program, adding in skills specific to correctional mental health providers to address needs specific to correctional populations. The CCM for Corrections also utilizes an adapted social cognitive model to enhance self-efficacy among correctional mental health providers. This aspect of the model focuses on the following characteristics:
- SDV knowledge;
- Beliefs related to prevention of SDV;
- "Stigmatizing beliefs about SDV and incarcerated persons;" and
- Mastery of skills related to SDV prevention.
The integration of social cognitive theory is meant to enhance self-efficacy.
The CCM for Corrections evidence-based curriculum proposed by the authors is built around 10 core competencies. These core competencies align with best practices of existing SDV prevention education programs, while also focusing on "improving knowledge, attitudes, stigmatizing beliefs, and perceived skills."
The core competencies are:
- "Managing attitudes and reactions" with regard to SDV;
- Maintaining an empathic and collaborative approach;
- Assessing an individual's SDV protective factors and risk factors;
- Focusing on "current SDV content;"
- Determining the current risk level of an individual;
- Collaboratively creating an "evidence-based treatment plan;"
- Coordinating or facilitating social support for the incarcerated individual;
- Accurately documenting "clinical decision-making;"
- Knowing the law with regard to SDV; and
- Committing to self-care and regular debriefing.
Although the authors have provided a comprehensive and detailed example of how to utilize the CCM for Corrections and create curriculum for training purposes, "[t]he educational program outlined in this article should be considered preliminary."
Because the CCM for Corrections has not yet been tested by practitioners in the field, the authors welcome inquiries from those who wish to collaborate on a pilot of the program or curricula.
For those interested in implementing or researching the model, the authors suggest considering the following:
- Collaborating with community and/or academic partners to improve curriculum;
- Making use of an advisory panel of experts who can provide feedback and assist with refining the program;
- Assessing the efficacy of both online and in-person program deployment;
- Gathering feedback from participants on the benefit of currently defined assessment tools; and
- Determining the impact of earlier integration into training (e.g., graduate programs, practicums, or internships).
"It is our hope that articulation of CCM for Corrections will spur community–academic partnership-driven testing and refinement of the approach toward AFSP’s goal of reducing SDV in correctional settings."
Inquiries for collaboration can be directed to the authors via the following institutions:
- Department of Public Health Sciences, University of North Carolina at Charlotte (Robert J. Cramer and Andréa R. Kaniuka)
- Behavioral Health Services, Division of Prisons, North Carolina Department of Public Safety, Raleigh, North Carolina (Lewis J. Peiper)
* References available upon request.